Stress of violence at work

[makawiliwili]

Hi I've been an acute forensic psych nurse for a decade at the same hospital.

I don't want to leave because I'm compensated well and have too much job security to leave.

Guess why the compensation is high and my job is secure.

Staff and patient injuries and assaults almost daily. Some severe. Hardened criminals with axis II, meth induced psychosis with nothing to lose. Geriatric psych patients with all their medical issues and alot of HIV/Hep patients who like to bite, scratch, self-mutilate.... Severely manic bipolar patients, mentally retarded sex offenders, it is unreal. Our staffing is 'okay'. Could be better but could be alot worse.

My question is this- is this job going to be the end of my spirit? I haven't seen patients get better, they may get to baseline, be discharged, and then come right back in worse shape. Some are lifers, serial killers who are NOT axis I but are conniving enough to have convinced the court to acquit and commit. It's depressing, after 10 years of this... I can't relate to normal people anymore! I've seen and read and heard too much about the horrible way people treat each other, and as a nurse, my nature is to care, so I don't want to be bitter, jaded, and cold.

The current economic environment has made people edgy, and I can feel the tension between staff members rising. A place like this is already fragile in that the team members have to be a cooperative healthy team or the patients will split us, escalate until we react, etc.

Anyone out there with experience in corrections/acute forensic psych in dangerous environments please comment on what I can do to last another 20 years here.

There are things about the work I love. We are a teaching hospital and because we have the most complex cases alot of research is done, and I am fascinated by the cases themselves. I have a good support network but that is balanced by the awful people that abound... who I try and avoid.

Has anyone ever taken a loooooong vacation, or switched shifts, or or or maybe ECT would help me hahaha.

On a daily basis work is fine, tolerable, challenging, rewarding but only in the sense that no one got hurt.

I know I wouldn't want any of my family members or loved ones working where I do, yet I do, does that mean I don't love myself?

We had an incident recently which is why I'm posting. People got hurt, some badly. The thing that irks me is the way our psych hospital treats us workers. When a few nurses called out sick the next day (understandably, it was a horrible event). the managers complain within earshot of others... no sensitivity at all. We risk our lives and are not armed, are expected to keep the patients safe and complete ten kajillion tiny tasks throughout our shifts but when we are hurt we get... nothing. Maybe some workman's comp for a while, maybe a call from our managers etc but there is a culture... a mood... almost like you must be to blame, or weren't you unlucky to have that happen. HELLO we work where cops fear to tread.

Thanks for letting me vent.

[Mr Ian]

Done a few years forensic and secure - tho your patient bunch sounds fairly difficult to work with. I only had one period of rough times and that was in a new private unit that wanted to build some cred' so they took anyone from anywhere for anything. In 2 years tho we were cherry picking.

It's hard to see what 'care' you're giving - or what good you're doing. I look at it in 2 main ways:

1. My primary care is to the general public. Ensuring only those who are of the least risk get discharged. It'c counter-intuitive to nursing to not want to discharge a patient but there are reasons for them that they wouldn't want to be exposed to risk either.

2. Looking for a 'cure' is sometimes impractical. Look for ways to help individuals be more at ease with themselves and those around them. Encourage skills that will serve them well on discharge. And in the least - acknowledge that no matter how bad any one individual is - not a single one of them wanted to end up there - it just happened that way.

The research part sounds interesting - I was never in a place that industrious.

Sometimes it's as well to get out for a while and after every 5-7 years it might be worth negotiating a 'holiday' to another facility or just taking an extended break. If you enjoy where you work more than your parent facility - then maybe you're right and you need a change.

[Jules A, MSN]

Hey There,

Wow that sounds like you need combat pay! I'd definitely consider a switch of some sort to keep you from totally getting burned out which could increase your chances of getting hurt. Are there different units you could transfer to? Please keep us posted.

[makawiliwili]

I actually do get hazard pay, and have the pick of units/shifts due to seniority. I'm working on the best shift I can, I have a lot of muscle between me and the dangerous patients, but it's not just my personal risk of injury that bothers me... it's seeing the violence, staff morale, and living in a state of hypervigilance for the entire time I'm there.

[inthesky]

This job sounds like it is really wearing on your mental health! Well-being is priceless. It wouldn't hurt to look around. You would be a great asset on another (less-acute) psychiatric unit! You could mentor junior nurses like me who are terrified of violent patients =P I hope that you do look around.

[MADHAT6]

WOW!Have you read your own description of how you feel? you sound like you know you need a break...read your own letter to us and treat it as if it was coming from a stranger then take your own advice,sounds like you need to work in a caring supportive environment for a while,even soldiers get leave ! thanks for what you are doing for all of us ! you have done more than your share !

[makawiliwili]

Thanks netsua, and all who responded. Things have been a little more bearable only because I've changed my attitude. I can't change the hospital, my coworkers, or administration, but I can choose to be happy.

I bring chocolate to work and try not to fret about the small stuff, be a support for the big stuff, and am trying to lighten up on myself and my need to always make things better. Some of our clients are just too unruly to be handled anywhere but on an acute unit, sometimes for life.

I love allnurses, I always find intelligent, witty, kind support. Thanks, it makes nursing (no matter what kind) so worth it.

[Shell5]

Maybe you can work there prn. Sounds like you like it. Or take some time off.

[frutipebsRN, BSN]

I feel your pain. I have worked on a psychiatric unit for the last 10 years as an LPN. I recently graduated with my BSN and have passed boards. I start Monday as an RN, and I must say I am not excited about it. Our doors are constantly revolving with the same patients who seem to be playing the system. Personality disorders who come in to manipulate, hook up, get a quick fix and start all over. Although we generally do not house forensic patients, we often get diversions from the state hospital,and the rise in violence within our facility has gotten out of control. The patients have nothing to lose as there are no consequences for their actions. If a police report is filed, the police act like it is something we deserve, afterall, we "chose" to work psych. I feel like I am in a rut...is this what nursing is really about? I find myself frustrated and easily aggitated related to my work stress. I know I should leave, but I can't right now, as my family depends on the benfits I have at my current facility, another words, I can't afford a lapse in insurance while switching jobs. I still have days where I enjoy my job, but those day are getting fewer and fewer. I hope I can get a handle on this before I become the patient instead of the nurse...lol:clown:

[elkpark]

While I've never worked in a designated forensics unit, I spent a few years working on a tertiary level acute adolescent unit (the kind of place where a year was not a long stay). A lot of our kids were kids who would have been in jail if they hadn't had rich, smart parents (who got them sent to us instead), and a good day was when no one got seriously hurt. And, yes, I loved the job and the work, except for the lack of support from administration (the same as you describe). It was the most challenging and stimulating job I've ever held. So I hear where you're coming from!

What I found helpful, as the charge nurse every time I worked, was to put about half my time and effort into making sure the rest of my staff was in good shape and good spirits (showing lots of interest, "touching base" with them frequently, giving out lots of compliments/praise -- so they knew that I, at least, appreciated what they were doing). That seemed to make the entire unit and shift run better. I also worked on taking good care of myself outside of work and having a good support network completely separate from work. I also made a point of initiating some changes on the unit to improve conditions and staff and client satisfaction with the program and, calmly and professionally, airing the staff concerns in our regular staff meetings with administration (no one else wanted to speak up) -- sure, they usually just blew me off and nothing ever came of it, but once in a while they listened and something was changed, and at least I knew I was doing everything I could.

I've also always found it helpful and refreshing, professionally, to attend as many professional conferences, seminars, etc., as possible, and to participate in my professional organizations, even if that means traveling a ways. I find it really nourishing and nurturing. Psych nurses tend to be a really cool group of people! Does your state nurses' association have specialty groups with monthly meetings? (I know some state NAs are more active, and have more to offer, than others -- mine is particularly active, and I feel v. fortunate in that regard). I'm guessing you're probably working for a state facility, and, in my experience, they are usually pretty good and flexible about at least giving people time off for continuing education/professional development, even if they aren't able to actually pay for it.

So few of us are willing to do this kind of work, and so few people are able to do it well -- remind yourself of that often, and hang in there! One does have to make peace with the fact that the reality of inpatient psych work these days is that you're going to be seeing the chronically mentally ill, the same folks over and over again -- that's true anywhere you work. A mentor of mine several decades ago talked with me about that and said that, in order to keep your own sanity and peace of mind, you have to redefine what "success" means -- you're probably not going to see many (if any!) cures, so you have to come up with your own definition/measurement of being successful in your work.

Best wishes!